Management and treatment of postmenopausal women with overactive bladder in genitourinary syndrome of menopause

Tikhomirova E.V., Balan V.E., Titchenko Yu.P.

Moscow Regional Research Institute of Obstetrics and Gynecology, Moscow, Russia

Objective: To optimize the therapy of overactive bladder in peri- and postmenopausal women.
Materials and methods: The study included 70 patients (mean age 57 years) with an average period after menopause of 6.3 years; the patients’ complaints were vaginal dryness, itching, burning, frequent urination during the day and/or at night, and urgent desire to urinate with or without incontinence. The women were divided into two groups: group 1 included 35 women who received estriol 0.5 mg (one dose of Ovestin intravaginally for 21 days daily, then one dose twice a week); group 2 included 35 patients who received a combination of the β3-adrenergic receptor agonist mirabegron (Betmiga 50 mg per day) and estriol 0.5 mg using the same scheme. The effectiveness of therapy was assessed with the help of filled questionnaires and diaries of urination, the findings of the examination and comprehensive urodynamic examination, G. Bachman score for the assessment of urogenital atrophy.
Results: Both groups showed a decrease in the incidence of pollakiuria, nocturia, urgency and urgent urinary incontinence after three months of treatment. The improvements were significantly more remarkable in the combination therapy group. There was a decrease in the severity of symptoms of genitourinary syndrome of menopause, including manifestations of vulvovaginal atrophy, in both groups.
Conclusion: Combination therapy with a β3-adrenergic receptor agonist (mirabegron 50 mg) together with local estrogens (estriol 0.5 mg intravaginally) is more effective against all symptoms of overactive bladder than monotherapy with intravaginal estriol. An important advantage of combination therapy is a two-fold decrease in the frequency of relapses. Local therapy with estriol is effective against the symptoms of vulvovaginal atrophy, both in the form of monotherapy and in combination treatment.

Authors’ contributions: Balan V.E., Tikhomirova E.V. – developing the concept and design of the study; Tikhomirova E.V., Titchenko Yu.P. – collecting and processing the material; Tikhomirova E.V. – writing the text; Titchenko Yu.P. – editing the text.
Conflicts of interest: Authors declare lack of the possible conflicts of interests.
Funding: The study was conducted without sponsorship.
Ethical Approval: The study was approved by the Ethical Review Board of Moscow Regional Research Institute of Obstetrics and Gynecology.
Patient Consent for Publication: The patients provided an informed consent for the publication of their data and photos.
Authors' Data Sharing Statement: The data supporting the findings of this study are available on request from the corresponding author after approval from the principal investigator.
For citation: Tikhomirova E.V., Balan V.E., Titchenko Yu.P. Management and treatment 
of postmenopausal women with overactive bladder in genitourinary syndrome of menopause.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2023; (12): 143-151 (in Russian)


urinary symptoms
vaginal atrophy
local estrogens
β3-adrenergic receptor agonist mirabegron


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Received 02.11.2023

Accepted 13.12.2023

About the Authors

Elena V. Tikhomirova, PhD, Senior Researcher at the Outpatient Department, Moscow Regional Research Institute of Obstetrics and Gynecology, 101000, Russia, Moscow, Pokrovka str., 22A, +7(925)820-11-14,,
Vera E. Balan, Dr. Med. Sci., Professor, Head of the Outpatient Department, Moscow Regional Research Institute of Obstetrics and Gynecology, 101000, Russia, Moscow, Pokrovka str., 22 A, +7(905)736-08-00,,
Julia P. Titchenko, PhD, Researcher at the Department of Prenatal Diagnosis, Moscow Regional Research Institute of Obstetrics and Gynecology, 101000, Russia, Moscow, Pokrovka str., 22A, +7(925)200-49-79,,

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